11 June 2012 12:50 AM

Appointments with a GP are vital to healthcare, yet 90% of patients are dissatisfied with the system

Appointments with a GP are vital to healthcare. 9 out of 10 patients say they are dissatisfied with the system.

As a country, we get the doctors and the medical services, and also the medical and national politicians, that we deserve.

If a sufficient number of people believe that they have rights and deserts, rather than responsibilities and duties, the inevitable result is the creation of a dependency culture. Politicians promise it. The electors vote for it. Then we are stuck with it.

Attempting to turn the clock back and withdraw benefits, to which people have become accustomed, is well nigh impossible.

Politicians tend not to be elected on a pledge to withdraw services. People will vote for a reduction in government expenditure only in so far as they themselves are not affected by it. They always want more for themselves.

The last government gave GPs a new contract that promised more pay for less work. The British Medical Association, like any other trade union, demanded it and the Labour government gave it to them. This gravy train for NHS doctors brought disastrous consequences to services for patients. 'Out of hours' work was no longer to be expected of GPs. They could delegate it to agencies - and most of them did.

Now, in a recent survey, patients are complaining about the difficulty in getting appointments within normal 'nine to five' working hours. Further, they complain that they cannot get office consultations outside their own working hours.

Doctors themselves have joined the entitlement culture, as will be seen on 21st June in their industrial action to protect their pensions. It is this same attitude that leads to doctors seeing no reason why they should provide services that differ, in public access, from that of any other government employees (even though each NHS GP technically contracts individually with the government for his or her services).

In this respect of comparability of the demands of state employees, doctors are no more concerned about NHS services than Bob Crow is over public transport services. Public service employees are nowadays more concerned for services for themselves.

That is what they vote for in strike action. They compare themselves with each other, rather than with their counterparts in the private sector.

NHS doctors who try to enter the full-time private sector often fail to survive in that competitive environment. They have to crawl back to the safety and security of the Nanny State.

They failed to understand that the three As of private practice are Availability, Affability and Ability. Private doctors have to be available at any time, they have to be polite and they have to polish their clinical skills. Otherwise they go out of business and deserve to do so.

NHS doctors, like other State employees, may well have these attributes as individuals but there is no significant sanction if they do not.

If the electorate votes for state services, this is the inevitable consequence right across the board. We see this in educational services just as much as in healthcare.

Patients want NHS doctors to provide services 24 hours a day, 7 days a week and to have the right to see the same doctor every time, in home visits as well as in the doctor's office.

That can't be done universally in a state system. Even in the private sector we have to have a break some time, although my wife knew that she married my telephone as well as me.

That was true for me even when I worked full time in the NHS. It may well be true for some NHS doctors today. That is their choice, as it was mine, but it is a different matter when patients demand a service that they would be unlikely to provide to consumers of their own services.

That is the entitlement culture that we live in nowadays and the situation will deteriorate even further until we recognise that we are no different from the Greeks, or other southern Europeans, in the expectation of something for nothing in state services. Nor will the financial, social and political consequences differ in this economic never-never-land.

The future of NHS GP services can be predicted already: a majority of part-time, mainly Asian, women doctors working in large polyclinics with 30 or more doctors working in shifts. That may or may not be what the public want but that is what they will get when they vote for state services.

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DR ROBERT LEFEVER

Dr Robert Lefever established the very first addiction treatment centre in the UK that offered rehabilitation to eating disorder patients, as well as to those with alcohol or drug problems. He was also the first to treat compulsive gambling, nicotine addiction and workaholism.
He identified 'Compulsive Helping', when people do too much for others and too little for themselves, as an addictive behaviour and he pioneered its treatment.
He has worked with over 5,000 addicts and their families in the last 25 years and, until recently, ran a busy private medical practice in South Kensington.
He has written twenty six books on various aspects of depressive illness and addictive behaviour.
He now provides intensive private one-to-one care for individuals and their families.

He has written twenty six books on various aspects of depressive illness and addictive behaviour.

He now uses his considerable experience to provide intensive private one-to-one care for individuals and their families.